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Debowska, A., Horeczy, B., Boduszek, D. et al. (2 more authors) (2022) Development and
validation of a stress response measure: the Daily Stress Response Scale (DSRS). Health
Psychology Report. ISSN 2353-4184

https://doi.org/10.5114/hpr.2022.116812

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health psychology report ·  Agata Debowska id
original article 1,2 · A,B,C,D,E,F
Beata Horeczy
3,4 · A,B,E
Daniel Boduszek id
5,6 · A,C,D,E
Dariusz Dolinski id
7 · A,B,E
Claudia C. von Bastian id
2 · A,E

Development and validation

of a stress response measure:
the Daily Stress Response Scale (DSRS)

background results
To date, there is a lack of measures for capturing a broad The DSRS is a 30-item, easy-to-use stress response mea-
spectrum of psychophysiological stress reactions that can sure with excellent psychometric properties. Based on CFA
be administered on a daily basis and in different contexts. results, the scale consists of two subscales, psychological
A need for such a measure is especially salient in settings and physiological stress response, which form associations
where stress processes can unfold momentarily and sub- with related external criteria.
stantially fluctuate daily. Therefore, the main aim of the
current study was to develop and validate the Daily Stress conclusions
Response Scale (DSRS), an instrument capturing a broad The DSRS is a reliable and valid measure of psychological
spectrum of psychophysiological stress reactions that can and physiological stress reactions that can be used to as-
be administered in real time and in different contexts. sess the stress response to daily stressors, including those
of an acute nature, such as a crisis, trauma, or surgery.
participants and procedure
The study was conducted in the early stages of the key words
COVID-19 pandemic in Europe. Participants were 7228 Daily Stress Response Scale (DSRS); stress response; con-
(81% female) Polish university students. The data were firmatory factor analysis (CFA); criterion-related validity;
collected anonymously through self-completion question- coefficient omega
naires. The DSRS was subject to confirmatory factor analy-
ses (CFA).

organization – 1: Faculty of Psychology and Law, SWPS University of Social Sciences and Humanities, Poznan, Poland ·
2: Department of Psychology, The University of Sheffield, Sheffield, United Kingdom · 3: Anesthesiology and Intensive
Care Department with the Center for Acute Poisoning, St. Jadwiga Provincial Clinical Hospital, Rzeszow, Poland ·
4: Medical College, University of Rzeszow, Rzeszow, Poland · 5: Faculty of Psychology, SWPS University of Social
Sciences and Humanities, Katowice, Poland · 6: Department of Psychology, University of Huddersfield, Huddersfield,
United Kingdom · 7: Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
authors’ contributions – A: Study design · B: Data collection · C: Statistical analysis · D: Data interpretation ·
E: Manuscript preparation · F: Literature search · G: Funds collection
corresponding author – Agata Debowska, Ph.D., Faculty of Psychology and Law, SWPS University of Social Sciences
and Humanities, 10 Kutrzeby Str., 61-719 Poznan, Poland, e-mail: [email protected]
to cite this article – Debowska, A., Horeczy, B., Boduszek, D., Dolinski, D., & von Bastian, C. C. (2022). Development
and validation of a stress response measure: the Daily Stress Response Scale (DSRS). Health Psychology Report.
https://doi.org/10.5114/hpr.2022.116812
received 13.10.2021 · reviewed 13.01.2022 · accepted 05.05.2022 · published 15.06.2022
 Background actions that can be administered repeatedly. A need
for such a measure is especially salient in contexts
Stress is an important construct in psychological and where stress processes can unfold momentarily and
medical research. However, stress is broadly defined substantially fluctuate on a daily basis, for example
and the term is used to refer to various processes, stress responses to a crisis, trauma, surgery, or hospi-
including exposure to potentially stressful situations, talisation. In such contexts, measures assessing stress
perception of those potentially stressful situations, over a one-week or one-month period are not suitable
and neural responses to those events (Epel et al., as they fail to capture the momentary and changing
2018). Although some existing stress scales contain nature of stress reactions. In addition, measures with
items referring to situations which may induce stress a longer reporting time period are subject to retro-
Agata Debowska, reactions (e.g., workplace stress scales such as the spective reporting bias. This is a serious limitation
Beata Horeczy, Nursing Stress Scale; Gray-Toft & Anderson, 1981), in the context of stress measurement because stress
Daniel Boduszek, the perception of stress is a transactionally based can affect autobiographical memory recall (Pezdek,
Dariusz Dolinski, process, guided by a person’s cognitive appraisal of 2003). Assessment of stress reactions which would
Claudia C. von an event and individual sensitivities to stress. This allow for frequent repeated sampling of participants’
Bastian indicates that the same situation can be stress-induc- experiences in real time aligns with the ecological
ing for one person and neutral for another (Hobfoll, momentary assessment (EMA) method, which is
1989; Lazarus & Folkman, 1984). On a biological level, hailed for its ability to minimise recall bias and maxi-
response to stress is mediated by two major stress mise ecological validity (Shiffman et al., 2008).
systems: the hypothalamus-pituitary-adrenal (HPA) The current study was conducted in the early
axis and the sympathetic nervous system (SNS). To- stages of the COVID-19 pandemic, i.e., when crisis-
gether, the activation of these systems orchestrates induced stress was very likely to occur. The time of
various psychological (e.g., feelings of anxiety, frus- widespread outbreaks of infectious diseases can be
tration, tension, and rumination) and physiological emotionally challenging and stressful to all persons
(e.g., increased heart rate, accelerated breathing, affected, and in particular those subgroups of the
muscle tension) processes (Desborough, 2000; Epel population that are at an increased risk of mental
et al., 2018; Gagnon & Wagner, 2016; Payne, 1999). health problems. One such vulnerable group is uni-
Although most aspects of the stress response are versity students (Wang et al., 2020). Theoretically,
adaptive (e.g., breathing accelerates to allow for extra high sensitivity to stress among university students
oxygen supply), repeated psychophysiological reac- is not surprising. Specifically, young university stu-
tivity can occur when a person perceives a discrep- dents (aged 18-24 years) are in a transitional devel-
ancy between the demands of the situation and their opmental stage between late adolescence and adult-
ability to cope with those demands (Caplan, 1983). In hood. “Emerging adulthood” is a difficult stage of
such maladaptive stress processes, an individual may development as it requires young adults to gain in-
experience elevation in affective states, such as anxi- dependence and self-sufficiency, as well as to build
ety and worry, as well as in physiological states, such and maintain intimate relationships. Achieving these
as vigilant preparedness reflected in the over-activa- important developmental milestones can be stress-
tion of the SNS (Epel et al., 2018). Notably, increased arousing and anxiety-provoking (Arnett, 2004; Mead-
levels of stress over an extended period of time have ows et al., 2006; Zirkel, 1992; Zirkel & Cantor, 1990).
been associated with negative mental health (e.g., At the same time, all university students, regardless
depression, anxiety, substance abuse) and physical of their developmental stage, have to face stressors
health (e.g., cardiovascular disease, high blood pres- associated with academic and financial demands that
sure, obesity, diabetes) outcomes (Cohen et al., 2007; may have an adverse effect on their mental health
Hammen, 2005). Exposure to extremely stressful (Dusselier et al., 2005). In considering the volume and
events (i.e., an acute stressor) may increase the risk diversity of demands that students have to deal with,
of cardiovascular problems (Holman et al., 2008) and any additional strain can be appraised as particularly
post-traumatic stress disorder (PTSD; Shalev et al., negative or threatening.
1998). Prior research has also indicated that stress ex-
perienced during hospitalisation can lead to reduced
outcomes in patients undergoing surgery, including The currenT sTudy
post-operative delirium (e.g., Cerejeira et al., 2013).
In addition, stress can be indirectly related to suicid- Taken together, there is a need for a measure of
ality. Specifically, Cheng and Chan (2007) reported stress that is easy to administer and score and can
that exposure to stressful events increased suicidality reliably assess a broad pattern of physiological and
through intensifying depression, substance use, and psychological responses repeatedly and in real time.
death acceptance. Therefore, the first aim of the current study was to
To date, there is a lack of measures for capturing develop the Daily Stress Response Scale (DSRS) –
a broad spectrum of psychophysiological stress re- a self-report scale designed to assess psychological

2 health psychology report

and physiological reactions to daily stressors, includ- ent in Polish). Of the 9,647 participants who met
ing acute stressors, in a context-free manner. Anoth- the study inclusion criteria, 7,228 (81% female) re-
er aim was to examine the psychometric properties turned satisfactory data. Therefore, the total comple-
(including factor structure, coefficient omega, and tion rate was 75%. Age ranged from 18 to 61 years
criterion-related validity) of the DSRS. The evalua- (M = 22.79, SD = 4.40, Me = 22). As for the level of
tion of the DSRS factor structure was achieved us- study, 1,761 (24.5%) participants were first year un-
ing confirmatory factor analysis. The evaluation of dergraduate students, 1,273 (17.7%) were second year
criterion-related validity was accomplished through undergraduate students, 1,384 (19.3%) were third
the strategy of correlating the DSRS subscale scores year undergraduate students, 1,385 (19.3%) were
with two previously validated self-report measures first year Master’s or fourth year medical students,
of stress and several self-report measures of traits re- 1,264 (17.6%) were second year Master’s or fifth/sixth The Daily Stress
lated to the construct of stress (depression, anxiety, year medical students, and 114 (1.6%) were postgrad- Response Scale
and suicidality). In considering students’ standing uate taught or postgraduate research students. As for (DSRS)
as a vulnerable population in terms of sensitivity to the subject of study, 1,480 (20.6%) participants were
stress, the scale was validated among a large sample psychology students, 1,075 (14.9%) were medical sci-
of university students during the early stages of the ences students (including medicine, nursing, and
COVID-19 crisis. paramedic science), and 4,638 (64.5%) were enrolled
on other courses (such as engineering, law, adminis-
tration, biology, archaeology, and architecture). The
PredicTions vast majority of participants (97.5%) were Caucasian
and born in Poland, which reflects the composition
Given that response to stress is a mixture of physi- of Polish society.
ological and psychological processes, we predicted
that the DSRS would be best captured by two latent
factors – the psychological and physiological stress daTa collecTion
response. We also predicted that the DSRS scores
would form moderate to strong positive correlations Ten large universities from all regions of Poland as
with the scores on already established measures of well as the Students’ Parliament of the Republic of
stress. Since those existing instruments consist pre- Poland, which is an organisation that brings together
dominantly of items assessing psychological reac- local governments from all universities, participated
tions to stress, we predicted that those correlations in the study. Students were invited to participate in
would be stronger for the psychological subscale the study via email invitations sent by university
of the DSRS. Further, we predicted that both DSRS representatives and announcements made on official
subscales would form moderate positive correlations institutional social media sites. The data were collect-
with depression and anxiety scores. Finally, since the ed anonymously through self-completion question-
relationship between stress and suicidality appears naires. Informed consent was requested from each
to be indirect (see Cheng & Chan, 2007), we predicted participant and ethical clearance was obtained from
that the DSRS subscales would form weak positive the research and ethical committees at all relevant
correlations with suicidality. Given the lack of re- institutions.
search in the area distinguishing between psycholog-
ical and physiological responses to stress, we did not
form any a priori hypotheses regarding which DSRS scale develoPmenT Procedures
subscales would form stronger associations with de- and oTher insTrumenTs
pression, anxiety, and suicidality.
The Daily Stress Response Scale (DSRS) was developed
to assess the daily stress response. Item generation
ParticiPants and Procedure for the DSRS relied on theoretical considerations
and discussions with a panel of experts (psycholo-
ParTiciPanTs gists and medical doctors). Initially, we assembled
26 items reflecting psychological (emotional and cog-
The present analyses are based on data collected nitive) stress reactions and 26 items reflecting physi-
among Polish university students in the early stages ological stress reactions. The initial item pool was
of the COVID-19 pandemic (March-April 2020). In sent to 20 medical doctors and psychologists who
total, 11,380 individuals accessed our online survey were asked to evaluate the clarity and conciseness
link and 10,056 consented to participate in the study, of scale items, assess whether each item taps into the
giving an 88% response rate. A total of 409 partici- construct we intended to measure, and to advise us
pants did not meet the study inclusion criteria (i.e., on which items should and should not be included
being a student at a Polish university and being flu- in the final version of the scale. As a result of this

 3
 content validity exercise, the item pool was reduced you ever said anything bad or nasty about anyone?”
to 30 items (15 for each dimension). Therefore, the The items were scored using a yes/no format. Total
DSRS is a 30-item measure assessing psychological scores ranged from 0 to 3, with higher scores indicat-
(15 items) and physiological (15 items) reactions to ing greater social desirability in responses. Socially
stress. For each statement, respondents are asked to desirable responding was operationalised as an over-
indicate on a 5-point Likert scale (0 – never, 1 – rare- all score at or above 2. Three hundred and sixty-eight
ly, 2 – occasionally, 3 – a lot of the time, 4 – nearly (368) participants recorded a score of 2 and 42 par-
all the time) to what extent it applied to them during ticipants recorded a score of 3. These participants
the last 24 hours. Scores on each subscale range from were excluded from analyses. The Polish version of
0 to 60, with higher scores indicating increased levels the scale was developed using the translation/back-
Agata Debowska, of psychological or physiological stress. In the cur- translation method. Discrepancies were resolved by
Beata Horeczy, rent sample, Cronbach’s α values for psychological discussion.
Daniel Boduszek, and physiological stress responses were .95 and .91,
Dariusz Dolinski, respectively.
Claudia C. von The short form of the Depression Anxiety Stress analyTical Procedure
Bastian Scales (DASS; Lovibond & Lovibond, 1995; Polish ad-
aptation: Makara-Studzińska et al., 2022) is a 21-item Descriptive statistics were calculated using SPSS ver-
measure that includes three subscales assessing sion 26. The dimensionality and construct validity
symptoms of depression (7 items), anxiety (7 items), of the DSRS were assessed using confirmatory fac-
and stress (7 items). For each statement, respondents tors analysis (CFA). Two competing models of the
are asked to use a 4-point Likert scale to indicate to DSRS were specified and tested using Mplus version
what extent it applied to them during the last week, 7.4 (Muthén & Muthén, 2010) with WLS estimation.
from 0 (did not apply to me at all) to 3 (applied to me Model 1 is a one-factor solution in which all 30 DSRS
very much or most of the time). Scores on each sub- items load on a single latent factor of stress reaction.
scale range from 0 to 21, with higher scores indicat- Model 2 is a correlated two-factor solution where
ing increased levels of depression, anxiety, or stress. 15 items load on the psychological stress response
In the current sample, Cronbach’s α values for de- factor and the remining 15 items load on the physi-
pression, anxiety, and stress scores were .87, .84, and ological stress response factor.
.88 respectively. The overall fit of each model and the relative fit
The Depressive Symptom Inventory – Suicidal- between models were assessed using a range of good-
ity Subscale (DSI-SS; Joiner et al., 2002; Metalsky ness-of-fit statistics: the χ2 statistic, the comparative
& Joiner, 1997) is a 4-item self-report questionnaire fit index (CFI; Bentler, 1990), and the Tucker-Lewis
designed to identify the frequency and intensity of index (TLI; Tucker & Lewis, 1973). Fit is considered
suicidal ideation and impulses. In the current study, acceptable if the CFI and TLI values are above .90
respondents were asked to report on suicidal ideation and good if they are above .95 (Van de Schoot et al.,
and impulses over the past 24 hours. Scores on each 2012). The root mean square error of approximation
item range from 0 to 3 and, for the inventory, from (RMSEA; Steiger, 1990) with 90% confidence interval
0 to 12, with higher scores reflecting greater severity is also presented. RMSEA values of about .05 or less
of suicidal ideation. The Polish version of the DSI-SS indicate a good error of approximation in the popula-
was developed using the translation/back-translation tion (Browne & Cudeck, 1993).
method. Discrepancies were resolved by discussion. Criterion-related validity for the DSRS subscales
Cronbach’s α for the entire sample was .93. was assessed using a series of pairwise correlation
The Perceived Stress Scale (PSS; Cohen et al., 1983; coefficients calculated in SPSS. In addition, the reli-
Polish adaptation: Juczyński & Ogińska-Bulik, 2009) ability of the DSRS was examined using coefficient
is a 10-item measure assessing how different situa- omega (McDonald, 1999).
tions affect an individual’s feelings and perceived
stress. Respondents are asked to indicate how often
they had certain feelings and thoughts in the last results
month on a 5-point Likert scale from 0 (never) to
4 (very often). Total scale scores range from 0 to 40, Descriptive statistics for two DSRS factors (psycho-
with higher scores indicating increased levels of logical stress reactions and physiological stress reac-
stress. Cronbach’s α in the current sample was .85. tions), PSS, DASS stress, DASS anxiety, DASS depres-
Lie scale. To control for social desirability bias, sion, and suicidality are presented in Table 1.
we used three items from the Eysenck Personality Fit indices for two alternative models of the DSRS
Questionnaire-Revised Lie scale (Eysenck et al., 1985). are presented in Table 2. The two-factor correlated
These were: (1) “Are all your habits good and desirable model provides the best fit to the data based on all
ones?”; (2) “Have you ever taken anything (even a pin statistics (CFI = .98, TLI = .98, RMSEA = .045, 90% CI
or button) that belonged to someone else?”; (3) “Have [.044, .046]).

4 health psychology report

Table 1

Descriptive statistics for the continuous variables

Variables M SD Observed Min. Observed Max.

DSRS Psychological 27.86 14.33 0 60
DSRS Physiological 12.43 10.48 0 60
PSS 21.06 6.90 0 40
DASS Stress 17.03 10.78 0 42
The Daily Stress
DASS Anxiety 9.21 9.11 0 42 Response Scale
DASS Depression 14.28 10.80 0 42 (DSRS)

Suicidality 1.30 2.09 0 12

Note. DASS – Depression, Anxiety and Stress Scale; DSRS – Daily Stress Response Scale; PSS – Perceived Stress Scale.

Table 2

Fit indices for two alternative models of the Daily Stress Response Scale

Models χ2 df CFI TLI RMSEA 90% CI

1. One-factor 6650.70* 405 .97 .96 .049 [.048; .050]
2. Correlated 2 factors 5848.75* 404 .98 .98 .045 [.044; .046]
Note. *Indicates χ2 is statistically significant (p < .05).

The appropriateness of the two-factor correlated discussion

model of the DSRS has also been determined based
on parameter estimates. As shown in Table 3, all Past research demonstrated that increased levels
items displayed statistically significant factor load- of stress over an extended period of time as well
ings. All factor loadings were acceptable, ranging as exposure to extreme stress can lead to negative
from .88 to .98 for the psychological stress response mental health and physical health consequences, in-
subscale and .77 to .95 for the physiological stress re- cluding depression, anxiety, substance abuse, PTSD,
sponse subscale. suicidality, post-operative delirium, cardiovascular
To assess the criterion-related validity of the disease, high blood pressure, obesity, and diabetes
DSRS, the DSRS subscale scores were associated (Cerejeira et al., 2013; Cheng & Chan, 2007; Cohen
with external variables. Table 4 shows that although et al., 2007; Hammen, 2005; Holman et al., 2008; Sha-
both DSRS subscales formed significant positive as- lev et al., 1998). Whenever possible, therefore, stress
sociations with external criteria, most of those as- responses in contexts known to be stress-inducing
sociations varied in strength. Specifically, the DSRS should be monitored in real time to allow for more
psychological subscale scores formed moderate effective prevention of long-term negative outcomes.
to strong positive correlations with the PSS, DASS However, there is a lack of context-free, easy to ad-
stress, DASS anxiety, and DASS depression scores. minister measures that comprehensively cover both
The DSRS physiological subscale scores were moder- psychological and physiological aspects of the stress
ately correlated with the PSS, DASS stress, and DASS response and yield themselves to the EMA methodol-
depression scores, as well as strongly correlated with ogy. To address these limitations, the main aim of the
DASS anxiety scores. The correlations between both current study was to develop and validate the Daily
DSRS subscale scores and suicidality scores were Stress Response Scale. The DSRS was found to be
positive yet weak. All these associations were in line captured by two factors – psychological and physi-
with our predictions. ological stress responses. The results of the present
Reliability of the DSRS factors was investigated study also provide strong support for the criterion-
using coefficient omega (McDonald, 1999). The re- related validity of the DSRS as a measure of stress.
sults suggest that both psychological (.99) and physi- As predicted, the DSRS was found to encompass
ological (.98) factors demonstrate excellent reliability two correlated factors, which is consistent with the
(calculations based on a two-factor solution). fact that stress is experienced at physiological (e.g.,

 5
 Table 3

Standardized factor loadings for the two factors of the Daily Stress Response Scale (DSRS) (correlation between
the two latent variables = .89)

DSRS items PS PH DSRS items PS PH

I have felt upset. .92 I have experienced breathing .93
I have felt anxious. .92 difficulties (e.g., fast or heavy
breathing, shortness of breath) even
I have felt tearful. .91 in the absence of physical exertion.
Agata Debowska, I have felt uneasy. .95 My heart has been beating fast even .94
Beata Horeczy,
Daniel Boduszek, I have been feeling overwhelmed. .94 in the absence of physical exertion.
Dariusz Dolinski, I have felt afraid. .95 I have felt tension in the muscles .82
Claudia C. von of my body (e.g., tension in the neck
Bastian I have been unable to concentrate. .90 or shoulders).
My thoughts have been mostly .95 I have had abdominal pains (e.g., .84
negative. stomach cramps or a dull ache in the
My thoughts have been racing. .88 tummy).
I have been worried. .95 My mouth has felt dry. .77
I have been thinking over and over .96 I have vomited or felt like vomiting. .84
about things that have upset me. I have felt chest pains. .88
I have been easily distracted. .90 I have been experiencing pulsing .86
I have been thinking over and over .95 in my ears.
about things that have made me My heart has been racing. .95
nervous.
In general, I have been sweating more .84
I have found it difficult to shake off .97 than usual.
negative feelings.
I have had difficulty swallowing foods, .88
I have found it difficult to shake off .98 without any apparent physical reason.
negative thoughts.
I have had a pounding feeling in my .92
head or chest.
I have felt lightheaded or dizzy. .87
I have felt tired. .83
I have been shaking or shivering. .88
Note. PH – Physiological subscale; PS – Psychological subscale. All factor loadings are statistically significant at p < .001. All items
are measured on a 5-point Likert scale (0 – never, 1 – rarely, 2 – occasionally, 3 – a lot of the time, 4 – nearly all the time). Instructions
for respondents: “Below is a list of common symptoms of stress. Please indicate how often in the last 24 hours, including now, you
have felt or experienced each of the following symptoms”.

increased heart rate, accelerated breathing, muscle showed that both the PSS and DASS are more strong-
tension, dry mouth) and psychological (e.g., feelings ly related to the DSRS psychological factor than the
of anxiety, frustration, tension, and rumination) lev- physiological factor. This was expected and indicates
els (Epel et al., 2018; Payne, 1999). In contrast, the that stress as assessed by these commonly used in-
currently available, most frequently utilised mea- struments is more of a reflection of the psychologi-
sures of stress (such as the PSS and DASS stress) are cal reaction rather than the physiological reaction to
typically shown to be represented by only one factor, stressors. Thus, future studies using the DSRS could
which does not reflect the complex nature of stress as contribute to a better understanding of predictors
a construct experienced in the body as well as in the and consequences of physiological stress.
mind. This also limits the predictive utility of those Interestingly, we found that the DSRS psychologi-
measures. More specifically, such instruments do not cal subscale scores formed a strong positive relation-
allow researchers to ascertain whether psychologi- ship with the DASS depression scores, whereas the
cal and physiological stress responses predict differ- DSRS physiological subscale scores were strongly
ent outcomes. Our criterion-related validity analyses associated with anxiety scores. This finding is consis-

6 health psychology report

Table 4

Associations between the two DSRS factors (psychological and physiological) and external variables

Variable DSRS DSRS PSS DASS DASS DASS Suicidality

Psychological Physiological Stress Anxiety Depression
DSRS Psychological – .66* .68* .73* .62* .71* .39*
DSRS Physiological – .49* .59* .77* .55* .33*
PSS – .71* .54* .67* .39*
DASS Stress – .70* .76* .40* The Daily Stress
Response Scale
DASS Anxiety – .65* .37* (DSRS)
DASS Depression – .55*
Suicidality –
Note. DSRS – Daily Stress Response Scale; PSS – Perceived Stress Scale; DASS – Depression, Anxiety and Stress Scale; *p < .001.

tent with the conceptual distinction between the two determine a cut-off score on the DSRS that differen-
disorders. Namely, depression is a mood disorder de- tiates between patients with and without those ad-
fined by having the feelings of guilt, helplessness, and verse outcomes. An improved understanding of a pa-
worthlessness, that is, symptoms strongly grounded tient’s stress response can aid clinicians in reducing
in cognitive and emotional processes. Symptoms of the risk of adverse outcomes. For example, patients
anxiety, in turn, are associated more frequently with with a particularly pronounced stress response prior
physiological reactivity, such as feeling on edge or to surgery could be targeted for psychological or ed-
restless, and irritability. Although anxiety and de- ucational interventions reducing stress and anxiety
pression are theoretically distinct, empirical investi- levels. In addition, the DSRS may be particularly use-
gations demonstrating differences between the two ful for studying stress and its outcomes among war-
have been rare, and anxiety and depressive disorders affected populations and refugees, including those
were shown to be bidirectional risk factors for one recently affected by the Russian invasion of Ukraine.
another (Dobson, 1985; Jacobson & Newman, 2017). Finally, since the DSRS was developed to enable the
Therefore, the current finding is important in that it measurement of stress reactions repeatedly over
points to possible developmental pathways to anxi- a period of time, future studies with the DSRS should
ety and depression. However, longitudinal research utilise the EMA methodology. If necessary and jus-
is needed to explore this possibility. tified by the context, such studies could reduce the
There are certain limitations to this study that DSRS reporting period from the last 24 hours to the
need to be considered. First, the results are based on last 12 hours or less.
self-report data which are subject to social desirabil- Overall, the DSRS is a 30-item, easy-to-use stress
ity bias. However, we tried to control for this by in- response measure with excellent psychometric prop-
cluding a lie scale and establishing stringent criteria erties. Based on CFA results, the scale consists of
for excluding responses from analyses. Another limi- two subscales, psychological and physiological stress
tation of the study is that the majority of participants response, which form associations with related ex-
were female. Even though women make up approxi- ternal criteria. The psychological stress response
mately 60% of the student population in Poland, in factor was more closely related to existing measures
our study the discrepancy between female and male of stress than the physiological stress response fac-
participants was larger (80% vs. 20%). However, our tor. Future studies should evaluate the psychometric
sample composition reflects the gender composition properties of the DSRS in greater depth and validate
of Polish medical students, 75% of whom are female the measure using populations drawn from various
(statistical data from Studencka Marka, n.d.). Still, settings, including those known to be particularly
future studies evaluating the DSRS should aim for stress-inducing.
a more gender-balanced sample. We also recommend
that future studies be conducted with more diverse
populations facing different types of stressors, in- References
cluding hospital patients awaiting minor and major
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 appendix a

Daily Stress Response Scale (DSRS)

The DSRS is a self-report scale designed to assess psychological and physiological reactions to daily stress in
a context-free manner.

Occasionally
Below is a list of common symptoms of stress. Please indicate how

the time (4)

A lot of the

Nearly all
Rarely (1)
Never (0)

time (3)
often in the last 24 hours, including now, you have felt or experienced

(2)
each of the following symptoms.
Agata Debowska,
Beata Horeczy,
Daniel Boduszek, 1. I have felt upset.
Dariusz Dolinski, 2. I have felt anxious.
Claudia C. von 3. I have felt tearful.
Bastian
4. I have felt uneasy.
5. I have been feeling overwhelmed.
6. I have felt afraid.
7. I have been unable to concentrate.
8. My thoughts have been mostly negative.
9. My thoughts have been racing.
10. I have been worried.
11. I have been thinking over and over about things that have upset me.
12. I have been easily distracted.
13. I have been thinking over and over about things that have made
me nervous.
14. I have found it difficult to shake off negative feelings.
15. I have found it difficult to shake off negative thoughts.
16. I have experienced breathing difficulties (e.g., fast or heavy
breathing, shortness of breath) even in the absence of physical
exertion.
17. My heart has been beating fast even in the absence of physical
exertion.
18. I have felt tension in the muscles of my body (e.g., tension in the
neck or shoulders).
19. I have had abdominal pains (e.g., stomach cramps or a dull ache
in the tummy).
20. My mouth has felt dry.
21. I have vomited or felt like vomiting.
22. I have felt chest pains.
23. I have been experiencing pulsing in my ears.
24. My heart has been racing.
25. In general, I have been sweating more than usual.
26. I have had difficulty swallowing foods, without any apparent
physical reason.
27. I have had a pounding feeling in my head or chest.
28. I have felt lightheaded or dizzy.
29. I have felt tired.
30. I have been shaking or shivering.
Items 1-15 – psychological response to stress.
Items 16-30 – physiological response to stress.

10 health psychology report

appendix b

Daily Stress Response Scale (DSRS) – Polish version

DSRS to skala samoopisowa, zaprojektowana do oceny psychologicznych i fizjologicznych reakcji na codzienny

stres w sposób bezkontekstowy.
Poniżej znajduje się lista typowych objawów stresu. Wskaż, jak często

Czasami (2)

Prawie cały
Rzadko (1)

Często (3)
Nigdy (0)

czas (4)
w ciągu ostatnich 24 godzin, w tym teraz, odczuwałeś/aś lub doświadcza-
łeś/aś każdego z następujących objawów.
The Daily Stress
Response Scale
1. Byłem/am zasmucony/a. (DSRS)
2. Byłem/am zaniepokojony/a.
3. Chciało mi się płakać.
4. Czułem/am się niespokojny/a.
5. Czułem/am się przytłoczony/a.
6. Odczuwałem/am obawę.
7. Nie byłem/am w stanie się skoncentrować.
8. Moje myśli były w większości negatywne.
9. Miałem/am gonitwę myśli.
10. Martwiłem/am się.
11. Wciąż myślałem/am o rzeczach, które mnie zasmuciły.
12. Łatwo było mnie zdekoncentrować.
13. Wciąż myślałem/am o rzeczach, które sprawiły, że byłem/am
zdenerwowany/a.
14. Trudno mi było pozbyć się negatywnych uczuć.
15. Trudno mi było pozbyć się negatywnych myśli.
16. Miałem/am trudności z oddychaniem (np. ciężki lub szybki oddech,
brak tchu), nawet kiedy nie wykonywałem/am żadnego wysiłku
fizycznego.
17. Moje serce szybko biło, nawet kiedy nie wykonywałem/am żadnego
wysiłku fizycznego.
18. Czułem/am napięcie w mięśniach (np. napięcie szyi lub ramion).
19. Miałem/am bóle brzucha (np. skurcze lub tępy ból).
20. Czułem/am suchość w ustach.
21. Wymiotowałem/am lub chciało mi się wymiotować.
22. Odczuwałem/am bóle w klatce piersiowej.
23. Czułem/am pulsowanie w uszach.
24. Moje serce waliło jak szalone.
25. Pociłem/am się bardziej niż zwykle.
26. Miałem/am trudności z połykaniem jedzenia bez wyraźnego
fizycznego powodu.
27. Odczuwałem/am pulsowanie w głowie lub klatce piersiowej.
28. Kręciło mi się w głowie.
29. Czułem/am się zmęczony/a.
30. Trząsłem/trzęsłam się lub drżałem/am.
Elementy 1-15 – psychologiczna reakcja na stres.
Elementy 16-30 – fizjologiczna reakcja na stres.

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